Trigger Points and the Nervous System: Myth or Reality?

There is a worldwide debate about whether trigger points (TrP) can be considered a relevant clinical entity with their own diagnostic criteria,[1] whether TrPs are just sensory and motor phenomena, secondary to other diseases, or whether the TrP phenomena are reliable enough to be meaningfully categorized.[2] The debate extends to the mechanisms that underpin TrP expression with some suggesting that they are the result of central sensitization processes while others suggest a more local tissue based sensitization. This topic has been previously discussed in a previous paper.[3] Based on current literature, it seems that TrPs are not the consequence of central sensitization. Recently, we explored the sensory characteristics of latent trigger points in order to determine the contribution central sensitization makes. Latent TrPs are hypersensitive muscular spots which induce a referred pain pattern when stimulated. Although latent TrPs are, by definition, non-painful until stimulated, their neurophysiological and clinical relevance is supported by the literature.[4] Our study, published in the Clinical Journal of Pain entitled “Exploration of quantitative sensory testing in latent trigger points and referred pain areas”[5] evaluated a battery of quantitative sensory testing over latent TrP within the extensor carpi radialis brevis and its referred pain area, and a contra-lateral mirror non-TrP area. We found that latent TrPs are associated with mechanical hyperesthesia, pressure pain hyperalgesia, and vibration hypoesthesia. None of these sensory changes were detected at a mirror non-TrP spot on the contralateral side (5).

Our findings raised that latent TrPs were found in asymptomatic (healthy) people who do not exhibit clinical manifestations of sensitization mechanisms, made us question whether central sensitization would be likely to contribute to this phenomenon? (3). If central sensitization is thought to induce bilateral changes (mirroring). why did we see significant differences in mechanical quantitative sensory testing between latent TrPs and a contra-lateral (non-TrP)?[6] Central sensitization is usually associated with a spread of pain and generalized hypersensitivity and if it underpins myofascial TrP expression, we wondered, how is it possible that a localized spot in a particular muscle fiber can elicit referred pain, and 1 or 2 centimeters above or under the same muscle fiber does not elicit referred pain?

Other clinical observations seem to support a local tissue contribution such as: when acute pain presents with associated TrPs, effective treatment of the TrP will resolve both the TrPs and the acute pain. Further, the patient may be asymptomatic for long periods of time, and sometimes the same pain does not reappear unless the causative factor is repeated. These observations suggest that TrPs are not the consequence of sensitization or a dysfunction of the nervous system, but a local tissue manifestation. Nevertheless, we should recognize that there are many gaps in the TrP theoretical and clinical framework and future studies are clearly needed.

About César Fernández-de-las-Peñas

Cesar Fernandez-de-las-Penas is a professor of physical therapy at Universidad Rey Juan Carlos, Madrid, Spain where he is the head division of a clinical research group focusing on pain sciences. Cesar has 18 years clinical experience in private practice and pain clinic, focusing on manual therapy approaches for the management of chronic pain. He conducted his PhD in biomedical sciences in the Centre for Sensory Motor Interaction (SMI) in Aalborg University, Denmark and a second PhD in Physical Therapy at the Universidad Rey Juan Carlos. His research activities concentrate on biomedical sciences within neuroscience, specifically on pain science and assessment in chronic pain patients and healthy subjects. Cesar has over 400 scientific publications, being leading researcher of approximately 160 of them.

Are you young with CRPS? We need your help!

Young people with CRPS and parents/caregivers are needed for research being conducted at Bath University

The study involves asking young people (14-25 years) with CRPS and parents of young people with CRPS to complete a 20-25 online survey which asks them to think about their future. Study recruitment is being conducted separately for both young people and parents. Please email crpsstories@bath.ac.uk if you would like to take part. Participants will be paid for their time.

PainAdelaide 2019

For you interstaters / internationallers – it is the day after Womad so combine a trip to the Festival City with one of the world’s truly great music festivals. Put it in your diary and we will let you know as soon as registration is up and running.

It’s impossible to slip your disc!

Lorimer Moseley answering the question “What is the thing that annoys you most when we talk about back pain?”

Online survey on bodily changes, sensations, and mood in people with chronic pain

How do CRPS and other chronic pain conditions affect bodily functions, sensations, and mood? Help CRPS researcher Janet Bultitude find out by responding to her survey.

The survey is aimed at people with CRPS, people with chronic pain conditions other than CRPS, and people without any chronic pain condition. The survey takes approximately 20 minutes and the responses are anonymous.

Prof Paul Hodges on pain and altered movement

Am I safe to move?

Listen to Lorimer Moseley talk to Karim Khan on new understanding of pain and focusing on the patient.

Understanding Pain

Regular physical activity is important for our health and well-being. Recent evidence suggests that independent of being physically active, limiting the duration of sedentary behavior, such as sitting or lying down, is important to reduce the risk for cardiovascular disease, diabetes, cancer and all-cause mortality (Biswas et al. 2015). Advances in wearable sensors provide a […]

We don’t normally have to think about our breathing and that’s because breathing is handled by a subconscious part of the brain called the medulla. The medulla automatically controls our breathing as well as our heart rate and blood pressure (Del Negro et al. 2018). It sends neural signals to the breathing muscles to activate them […]

Got an event or meeting you want to promote?

We might be able to help you spread the word. Tell us in an email,

Who is the convenor?
Who is the contact person?
Where and when is it?
Is it non-profit, an association meeting or a commercial venture?
What is the objective?
Who are you wanting to attend?
Where can people go to find out more?

Then contact Heidi@bodyinmind.org

BiM will no longer have comments

Dear BiM Community
We have come to the difficult decision to stop comments as this feature is no longer serving its intended function for the wider readership of BiM. Our aim is to facilitate and disseminate good clinical science research, the comments section were for folks to engage with this research constructively and not promote individual views or therapies. We feel this function is now not being fulfilled.

Archives

Archives

Looking for information?

We often get people writing in about their particular conditions asking for more information and help. Unfortunately we get too many to be able to respond personally. We do not publish these comments for privacy reasons and we cannot offer treatment advice.

All blog posts should be attributed to their author, not to BodyInMind. That is, BodyInMind wants authors to say what they really think, not what they think BodyInMind thinks they should think. Think about that!

Subscribe!

All blog posts should be attributed to their author, not to BodyInMind. That is, BodyInMind wants authors to say what they really think, not what they think BodyInMind thinks they should think. Think about that!

We aim to facilitate and disseminate good clinical science research. We love comments that engage with the research and are constructive and respectful. We do not prescribe treatments. Promotion of your particular therapy in the comments section is not appropriate here either - that is not the point of BiM. Finally, all the comments that are made reflect the views of the person who made them and are not endorsed by BiM or members of the BiM research group.